Our long-term goal is to decrease health care disparities for rural patients with cardiovascular disease. The objective of this proposal is to determine if changes in national guidelines for the treatment of patients with myocardial infarction (Ml) have correlated with changes in patterns of care for rural patients with Ml. To accomplish this objective, we will use a hospital discharge database from the years 2000 and 2004 to compare the proportion of rural patients with Ml that received care in referral hospitals offering cardiac revascularization procedures versus those that only received care in local hospitals not offering such services. We will determine if this proportion has changed over the period of time during which new national guidelines were released to recommend an early invasive treatment strategy for a larger group of patients. We will also determine if these outcomes vary with the distance between where a patient lives and the closest referral hospital. We will use a geographic information system (GIS) to perform these analyses. Our research will identify potential disparities in access to care for rural patients with Ml. It will also further develop GIS as a useful method for evaluating new programs and polices aimed at reducing such disparities. [unreadable] [unreadable]